Neurology diagnoses and treats disorders of the nervous system, including the brain, spinal cord, and nerves, as well as thought and memory.
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Essential Tremor is often progressive. While it does not shorten life expectancy, the amplitude of the tremor tends to increase with age, eventually interfering with all activities of daily living (ADL). Long term care involves monitoring for functional decline. Patients may eventually lose the ability to write, eat soup, or drink from an open cup.
In Parkinson’s disease, the tremor may fluctuate or even decrease in late stages as rigidity takes over, but the overall disability increases. Long term management requires a dynamic adjustment of therapies to balance tremor control against the side effects of increasing medication doses, such as dyskinesia or hallucinations.
Tremor carries a heavy social burden. Patients often withdraw from social dining or public speaking due to embarrassment. The “coffee cup sign”—spilling while drinking—can be a source of profound shame. Anxiety about shaking in public creates a feedback loop, releasing adrenaline that makes the shaking worse.
Long term care must address this social isolation. Treatment of comorbid anxiety and depression is essential. Support groups provide a space where patients do not have to hide their shaking. Cognitive Behavioral Therapy (CBT) can help patients manage the social anxiety and break the cycle of embarrassment and exacerbation.
For patients with Deep Brain Stimulation, long term care involves the maintenance of the hardware. Batteries (IPGs) need replacement every 3 to 5 years (for non rechargeable) or 15+ years (for rechargeable). Leads can migrate or fracture over decades. Regular programming adjustments are needed to maintain efficacy and minimize side effects like slurred speech (dysarthria).
Stimulation induced side effects can emerge over time. “Tolerance” to stimulation is debated, but disease progression often requires changing the electrical parameters. Neurologists must balance tremor suppression with side effects like balance problems or paresthesias that can arise from spread of the electrical field.
Severe head or jaw tremor can impact chewing and swallowing. Patients with advanced tremor often lose weight due to the sheer caloric expenditure of the constant movement and the difficulty in getting food to the mouth. “Tremor related weight loss” is a real clinical entity.
Dietary modifications may be necessary. Using straws, sippy cups, or plate guards can maintain independence. In severe cases, high calorie supplements are needed to offset the metabolic demand. Evaluation by a Speech Language Pathologist is crucial to ensure swallowing safety and prevent aspiration.
Living with a chronic movement disorder requires the development of “workarounds.” Patients learn to brace their elbow on the table to steady their hand, or use two hands to hold a glass. They may switch to digital signatures or voice to text software as handwriting becomes illegible.
Technology plays a growing role. Voice activated assistants allow patients to dial phones or send messages without needing fine motor control. Long term care providers act as resources for these adaptive technologies, ensuring the patient remains connected and autonomous despite the motor deficit.
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In Essential Tremor, the shaking usually gets “larger” (higher amplitude) but slower as you age, often making tasks like eating more difficult over time.
Yes, if the tremor is severe enough to prevent you from performing your job duties and has not responded to treatment, it can qualify as a disability.
Non rechargeable batteries typically last 3 to 5 years depending on the settings; rechargeable ones can last 15 years or more but require daily or weekly charging.
This is a common side effect if the electrical stimulation spreads to nearby fibers that control the tongue and mouth; the doctor can usually fix this by adjusting the programming.
Most people with tremor can drive safely, but if the tremor is severe in the arms or legs, or if you have a condition like Parkinson’s that affects reaction time, you may need a driving evaluation.
essential tremor About 10 million people in the United States deal with uncontrollable shaking, often in their hands. This is called essential tremor. It makes
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